Oral motor-treatment-special-web-forum

Special Web Forum on
Oral Motor Treatment
From the ASHA Member Forums
http://forums.asha.org/discussion?128@@.ef3740f
September 23, 2003
Sponsored by Special Interest Divisions 1 (Language Learning and
Education), 2 (Neurophysiology and Neurogenic Speech and Language
Disorders), 4 (Fluency and Fluency Disorders), 5 (Speech Science and
Orofacial Disorders), 13 (Swallowing and Swallowing Disorder), and 16
(School-Based Issues).
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topic created 11 Sep 2003 by sysop
NOTE: This discussion is now a read-only archive. Members who wish to continue this discussion
among themselves are encouraged to start appropriate topics in the Speech-Language Pathology
Discussion area here on the Member forums.
Straws and whistles, bite-blocks, nuk brushes, sensory and motor stimulation -- the list of oral
motor treatments goes on. Do they work? How do they work? When do they work? How do you
know if they worked for a specific client? A panel of experts helped members explore these
questions on a Web forum held September 23, 8-10 pm, ET. The event was sponsored by Special
Interest Divisions 1 (Language Learning and Education), 2 (Neurophysiology and Neurogenic
Speech and Language Disorders), 4 (Fluency and Fluency Disorders), 5 (Speech Science and
Orofacial Disorders), 13 (Swallowing and Swallowing Disorder), and 16 (School-Based Issues).
DISCLAIMER: All comments are the opinions of the individuals who took part in this Web forum
and do not necessarily reflect the official opinion of the association, nor does a mention of a
commercial product here imply a recommedation for such a product by the association.
The Expert Panel sysop - 11:36am Sep 16, 2003 EST (#1) {Bookmark}
Joining us in the ASHA Member Forums for this event will be the following special
guests:
Debra Beckman, MS, CCC-SLP
Beckman & Associates, Inc.
Developmental Therapy Clinic
Winter Park, FL
Heather M. Clark, Ph.D. CCC/SLP
Associate Professor, Department of Language, Reading, & Exceptionalities, Appalachian
State University
Boone, NC
Karen Forrest, Ph.D.
Professor, Department of Speech and Hearing Sciences, Indiana University
Bloomington, IN
John E. Riski, Ph.D., CCC-S, FASHA
Director, Speech Pathology Laboratory
Clinical Director, Center for Craniofacial Disorders
Atlanta, GA

JoAnne Robbins, Ph.D.
Professor, Department of Medicine, University of Wisconsin
and
Associate Director for Research, Geriatric Research, Education and Clinical Center
(GRECC)
Wm S Middleton VA Hospital
Madison, WI
Recommended Reading sysop - 11:46am Sep 16, 2003 EST (#2) {Bookmark}
In anticipation of this event next week, the experts have submitted some
recommended reading for you to review before the live discussion (which will happen in
this spot--instructions for "keeping up" with the event while it is occuring to be posted
later).
All of these documents are in Adobe Acrobat PDF format. You can obtain the free
Acrobat Reader software for viewing and printing these files from
http://www.adobe.com/
sysop - 11:48am Sep 16, 2003 EST (#3) {Bookmark}
"Range of Movement and Strength in Oral Motor Therapy: A Retrospective Efficacy
Study"
Debra A. Beckman, M.S., CCC-SLP
Carrie D. Neal, M.A., CCC-SLP
Jason L. Phirsichbaum, M.A., CCC-SLP
Lisa J. Stratton, M.A., CCC-SLP
Virginia D. Taylor, M.A., CCC-SLP
David Ratusnik
University of Central Florida
"Assessment and Treatment of Neuromuscular Impairments"*
Attachments: beckman.pdf

Heather M Clark, Ph.D. CCC/SLP
Associate Professor
Department of Language, Reading, & Exceptionalities
Appalachian State University
Boone, NC
*This presentation is based on the manuscript
"Neuromuscular Treatments for Speech and Swallowing: A Tutorial" (in press, AJSLP)
"Oral Motor Training and Treatment for Apraxia of Speech"
Linda I. Shuster
West Virginia University, Morgantown
"Nonspeech Oral Motor Treatment Approaches for Dysarthria: Perspectives on a
Controversial Clinical Practice"
Megan M. Hodge
University of Alberta
Edmonton, Alberta, Canada
Sessions at ASHA Convention in Chicago sysop - 12:01pm Sep 16, 2003 EST (#7) {Bookmark}
There will be a number of sessions regarding oral motor treatment at this year's
convention, including:
Thursday, Nov 13 2003 8:00 AM (60 Min)
McCormick Place Convention Center, N230
Physiological Rationale for Passive Exercise & Physical Modality Treatments
Attachments: ClarkHandout.pdf
Attachments: D2v11n4Shuster.pdf
Attachments: D2v12n4Hodges.pdf

Presenter: Clark, Heather
Thursday, Nov 13 2003 11:00 AM (60 Min)
McCormick Place Convention Center, E354b
Assessments of Children’s Oral & Speech Motor Skills: A Review
Presenter: Strand, Edythe
Thursday, Nov 13 2003 1:30 PM - 3:00 PM
Poster McCormick Place Convention Center, Hall E
Effectiveness of Oral Motor Treatment in SLP
Presenter: Lass, Norman
Thursday, Nov 13 2003 1:30 PM (15 Min)
Specificity of Training in the Lingual Musculature
Thursday, Nov 13 2003 3:15 PM (15 Min)
Relationship Between Measures of Isometric & Isotonic Endurance
Friday, Nov 14 2003 8:00 AM (120 Min)
McCormick Place Convention Center, E451a
Applying Exercise Physiology Principles in Oromotor Rehabilitation for Dysphagia
Presenter: Pfalzer, Lucinda
Saturday, Nov 15 2003 8:00 AM (60 Min)
McCormick Place Convention Center, E258
How to Decide Which Speech Treatment Approach to Use
Presenter: Kamhi, Alan
More Reading sysop - 09:06am Sep 17, 2003 EST (#8) {Bookmark}
"Nonspeech oral-motor exercises"
Karen Forrest
Indiana University
Reading Attachments sysop - 08:50am Sep 22, 2003 EST (#9) {Bookmark}
Attachments: Nonspeech oral-motor exercises forum_1.pdf

To read the attachments above, you'll need the free Adobe Acrobat reader (available
for download from http://www.adobe.com). If, when clicking on the links above, you
get a message asking what to do with the document, save it to your harddrive (make
sure you know where you are saving it to, and give the document a descriptive name),
then doubleclick the document to open it in Acrobat reader outside your browser.
Additional Reading sysop - 03:28pm Sep 22, 2003 EST (#10) {Bookmark}
"Coordination of Lip Muscle Activity by 2-Year-Old Children During Speech and
Nonspeech Tasks"
by
Jacki L. Ruark, University of Tennessee, Knoxville
Christopher A. Moore, University of Washington, Seattle
fromJSLHR, Volume 40, 1373–1385, December 1997
CPT Codes and Oral Motor Treatment sysop - 04:04pm Sep 23, 2003 EST (#11) {Bookmark}
Speech-language pathologists can use procedure (CPT) codes in the 97000 series
(Physical Medicine and Rehabilitation) as well as procedure codes in the 92500 series
(Special Otorhinolaryngoloic Services); but not in combination.
A speech-language pathologist might use 97112 (neuromuscular re-education) when
working on oral motor skills, but speech-language pathologists usually do oral motor
work as part of speech treatment, which is reported under 92507 (treatment of speech
and language disorders). To report 97112 and 92507 would constitute unbundling or
duplicate billing as the vignette for 92507 includes improving oral motor coordination.
That being said, a speech-language pathologist working on tongue thrust without a
speech problem might use 97112 to describe the treatment provided.
Questions? Contact Maureen Thompson (mthompson@asha.org or extension 4431) or
Janet McCarty (jmccarty@asha.org or extension 4194, Tues. and Wed.).
More Additional Information sysop - 04:17pm Sep 23, 2003 EST (#12) {Bookmark}
Attachments: Ruark.pdf

For those of you who have access to a university library, you might be interested in the
following article: "Oral stimulation accelerates the transition from tube to oral feeding
in preterm infants" by Sandra Fucile, MSc, OTR, Erika Gisel, PhD, OTR, and Chantal
Lau, PhD, published in the Journal of Pediatrics, 2002, 141:230-6.
FORUM TONIGHT!
Thanks to everyone for their interest in this topic and forum! ASHA and the sponsoring
special interest divisions really appreciate your enthusiasm.
Right now, this forum is set to read-only, but at 8pm tonight it will switch to a full
forum, with a blank white box at the end for your questions. When asking questions,
please remember that we have five guests tonight.
During the event, hit the refresh button (on IE, a pair of green arrows pointing to each
other on your toolbar; on Mozilla/Netscape, an arrow circling a document) every 5-10
minutes to update your screen and see what is being written.
If you need technical assistance, contact gengelcox@asha.org (due to problems with
ASHA's email system due to Hurricane damage) engelcox@hotmail.com during the
event.
Joanne Robbins Joanne Robbins - 07:29pm Sep 23, 2003 EST (#13) {Bookmark}
This is a test message.
Greetings sysop - 07:31pm Sep 23, 2003 EST (#14) {Bookmark}
Hi, Joanne! Glad you could make it tonight. If the other presenters could also post a
test message, that would be grand!
Karen Forrest Karen Forrest - 07:33pm Sep 23, 2003 EST (#15) {Bookmark}
Hi,
I'm also logged on.
Karen

Excellent, Karen. Thanks to you and Joanne, and our other presenters, for making
yourselves available for this forum tonight!
We're still about 25 minutes before the actual start of this thing, so grab yourself
something to drink and do some typing exercises to flex those finger muscles--it's
going to be a fun and informative two hours, I'm sure!
Heather Clark clarkhm - 07:37pm Sep 23, 2003 EST (#17) {Bookmark}
Welcome everyone! I'm looking forward to the discussion.
And Heather makes three! I like this group--not just on time, but early. Wow!
Amy Weiss louise - 07:41pm Sep 23, 2003 EST (#19) {Bookmark}
Just so you'll know there's an audience out there, I thought I'd say hello to you all from
Iowa City.
And hello back to Iowa City, home of the best creative writing program in the country!
(Okay, so that was off-topic. Bad sysop, bad.)
Given the number of emails and phone calls I've responded to in the last week, I
suspect there's a number of people in the audience tonight. I hope some of them have
questions, too!

Good evening. This is JoAnne Robbins in Madison Wisconsin. Please let me know who is
on early (before 7 Central Time). Thanks.
Sherri Lovick SLovick - 07:47pm Sep 23, 2003 EST (#22) {Bookmark}
Good Evening from Post Falls Idaho!
Keeping up with the discussion sysop - 07:51pm Sep 23, 2003 EST (#23) {Bookmark}
Just a technical note--due to how some browsers "cache" information to the hard drive,
make sure that when you use the REFRESH button to see what's been posted since you
last refreshed, hold down the CTRL key, which will force your browser to get the most
recent information from the Web.
Also, note that right under the heading, there's links to FIRST, PREVIOUS, NEXT and
ALL. These can help you move through the discussion--FIRST takes you to message
#1, PREVIOUS will jump you back a few messages, NEXT will grab the next few
messages, while ALL will send the whole discussion to your screen (which might get
pretty long given the interest on this topic!).
Patricia Burke Pat Burke - 07:51pm Sep 23, 2003 EST (#24) {Bookmark}
Hello from Melbourne, Fl
Beth Muller beth muller - 07:53pm Sep 23, 2003 EST (#25) {Bookmark}
Hello from Bethel, CT

Sandy Ryan sandy ryan - 07:54pm Sep 23, 2003 EST (#26) {Bookmark}
Hello from beautiful Flagstaff, Arizona!
Heather,
I don't see the article from the SID13 Newsletter that I authored on Lingual Strength
and Exercise listed in the above listed readings for this Web Forum. Wasn't Jean White
or someone at ASHA going to post it?
Teresa Brobeck tbrobeck - 07:54pm Sep 23, 2003 EST (#28) {Bookmark}
Howdo from NMSU in Las Cruces! I'm running between this and my class tonite, but I'll
keep hitting the "refresh" button as suggested :-). Thanks to all the discussion leaders
for this forum!
Pat Bates pat bates - 07:54pm Sep 23, 2003 EST (#29) {Bookmark}
Good Evening from Lawrence, Kansas
Marlene Pettiford mapslp - 07:55pm Sep 23, 2003 EST (#30) {Bookmark}
Hello all from Columbus Indiana
Keeping up with the discussion sysop - 07:56pm Sep 23, 2003 EST (#31) {Bookmark}
It's great to see all these people from so many parts of the country! Thanks for

attending tonight's Web event.
Joanne, it looks like that may have been my mistake. I'll make sure to get that article
posted tomorrow so that people can check back here to read it after tonight's
discussion.
Joanne, I will attach it here
Jill Georges jgeorges - 07:58pm Sep 23, 2003 EST (#33) {Bookmark}
Hello from Kansas City, KS
Introductions sysop - 07:58pm Sep 23, 2003 EST (#34) {Bookmark}
According to the clock on my computer here, it's time to get this show rolling!
First off, I'd like each of the presenters to give a short introduction to themselves and
their relation to oral motor treatment.
Would it be possible for someone at ASHA to post all the articles and resources
mentioned tonight on the web page after the event?
Anne Marie Newman anewman - 07:58pm Sep 23, 2003 EST (#36) {Bookmark}
And also, a big hello from Naples, Florida.
Attachments: Robbins article.pdf

Pamela Horrocks pamela horrocks - 07:58pm Sep 23, 2003 EST (#37) {Bookmark}
Hello from Willimantic Ct. Looking forward to this discussion!
Daniel Britchkow DBritchkow - 07:59pm Sep 23, 2003 EST (#38) {Bookmark}
Hi, I'm writing from U of Pitt. How effective is oral-motor exercises? What are the
statistics or justification for them?
Dianne Handy dhandy - 07:59pm Sep 23, 2003 EST (#39) {Bookmark}
Hello from Washington, DC
Michael Hammer mhammer - 07:59pm Sep 23, 2003 EST (#40) {Bookmark}
And another warm greeting from Lawrence, KS. Hi Pat!
Hi, this is Heather Clark from Boone, NC. My interest in this topic is from the
perspective of theoretical/physiologic rationale for oral motor treatments: How do they
effect the motor system?
John Riski JRiski - 08:00pm Sep 23, 2003 EST (#42) {Bookmark}
Hi, from Atlanta.
Looks like we have a crowd already.

Jay
Fran Redstone franredstone - 08:00pm Sep 23, 2003 EST (#43) {Bookmark}
Dr. Clark,
Regarding strength and range of motion in children with oral problems, do we know
how much is enough? Are there norms?
Jessica Goldberg Jessica Goldberg - 08:00pm Sep 23, 2003 EST (#44) {Bookmark}
hello from bronx ny
Linda Schmitke Schmitke - 08:00pm Sep 23, 2003 EST (#45) {Bookmark}
Hello from beautiful Oregon.....GO DUCKS!!!!
Gregory Lof Gregory Lof - 08:00pm Sep 23, 2003 EST (#46) {Bookmark}
Hi from Boston!
Fran,
Although many studies have reported that individuals with dysarthria and/or some
types of dysphagia exhibit weakness, the relationshiop between strength and function
is not clear enough to identify "how much is enough."
Clouding the picture is "how much is enough to move quickly" in addition to producing
adequate force.

Archive of Tonight's Discussion sysop - 08:02pm Sep 23, 2003 EST (#48) {Bookmark}
Sandy Ryan asked "Would it be possible for someone at ASHA to post all the articles
and resources mentioned tonight on the web page after the event?"
We will be making a "zip" file that contains this discussion and what articles/resources
we can obtain permissions for available to members on the Web site, yes.
Jacquelyn Fowler Jacquie F. - 08:02pm Sep 23, 2003 EST (#49) {Bookmark}
Hi from Stafford, NY. I'm looking forward to learning via a web forum.
Barbara Lambiase Barbara Lambiase - 08:03pm Sep 23, 2003 EST (#50) {Bookmark}
Hi from New Jersey
Lisa McDonald mcdonal - 08:03pm Sep 23, 2003 EST (#51) {Bookmark}
Hello from Greensboro, NC
is there any way to help paresis from a chronic bell's palsy?
Fran

Great question. Do you think ROM and strength are always related?
Jay Riski
Caroline Bowen Caroline Bowen - 08:04pm Sep 23, 2003 EST (#54) {Bookmark}
G'day everyone, It's just after 10 am on Wednesday on a beautiful Spring morning
here in Sydney, Australia. Thanks to the presenters and organisers for the terrific
selection of articles. I have been reading for days!
Cindy Katzoff cask51454 - 08:04pm Sep 23, 2003 EST (#55) {Bookmark}
Hello from Milwaukee. Will the whole discussion be available somewhere to read
afterwards?
Louise Louise522 - 08:05pm Sep 23, 2003 EST (#56) {Bookmark}
We are a three-some in Charlotte: 3 SLPs!
Hi, This is Karen Forrest from Indiana University in Bloomington. I'm interested in
treatment efficacy, in general, and particularly as it relates to children with speech
disorders of unknown origin and adults with dysarthria. In line with some of the
previous questions, I am interested in having empirical information about efficacy of
oral-motor treatments.
Regarding Questions sysop - 08:05pm Sep 23, 2003 EST (#58) {Bookmark}
I'm going to be trying to keep track of the questions in another window, so that we can
make sure they don't get lost in this wild online format.

Pamela Horrocks pamela horrocks - 08:05pm Sep 23, 2003 EST (#59) {Bookmark}
Can you provide some references for efficacy studies regarding oral-motor treatment?
My concern is with how many people are using OME to change speech sound
productions in children. The data seem clear to me that there is no relationship
between non-speech exercises and speech sound changes. I perfer to let the data
guide clinical practice....
Evelyn Cole ebcslp - 08:05pm Sep 23, 2003 EST (#61) {Bookmark}
Hello from TN
Hi- Nice to have so much interest on line relative to the topic at hand.
My work in this area is relatively focused on the use/effectiveness of oral exercise on
swallowing and related outcomes, largely in adults although I also am interested in the
younger population.
And Greg Lof, how long have you been in Boston? How many years of your life have I
missed?!
Jay, I like your question. Certainly other neuromuscular impairments in addition to
weakness can affect ROM. Hypertonia, particularly in the case of the jaw, comes to
mind, and perhaps rigidity/hypokinesia as in Parkinson's disease.

Lindsay Geddis Lindsay Geddis - 08:06pm Sep 23, 2003 EST (#64) {Bookmark}
Hi from NY
Debra Lowsky debraclowsky - 08:07pm Sep 23, 2003 EST (#65) {Bookmark}
Thanks for having a forum. Debbie Lowsky from Columbia, SC!
Hi, Joanne! Glad you are speaking from the swallowing point of view....as you know, I
am in the "child phonology" point of view....
with adults following strokes is there a minimum amount of tone which must remain to
expect return in buccal/facial mm.?
Greg's response (speech versus non-speech) is related to issues of motor learning.
Principles of motor learning indicate that “part to whole” practice strategies (breaking
the movement down into its component parts and practicing each movement
separately) are not as effective as practicing the whole movement.
Andrea Tobochnik Andrea - 08:09pm Sep 23, 2003 EST (#69) {Bookmark}

Question from Kalamazoo:
Is there data to support the effectiveness of any specific oral motor exercises for
improving oral bolus control in adults with dysphagia?
This is Jay Riski. I direct a craniofacial program in Atlanta and I am interested speech
problems related to VPI and apraxia. I would like to hear anyone's experiences using
OME in these populations with/without traditional speech therapy.
Aileen Montag SLPAl - 08:10pm Sep 23, 2003 EST (#71) {Bookmark}
Hi from NY
Effectiveness Questions sysop - 08:11pm Sep 23, 2003 EST (#72) {Bookmark}
Presenters, Daniel Britchkow and others have posted questions regarding effectiveness
of oral-motor exercises. Is there a link or reference to an article that they can go to for
studies of these? (Are their references to studies in the articles already posted here?)
Jessica,
I think one area where we struggle is even identifying/quantifying muscle tone. Are
judgements based on degree of facial droop? Or do SLPs assess tone in ways that
other disciplines do, by gauging resistance to passive movement.
I don't know of any norms for facial tone, much less information on predicting recovery
from tone.

Pamela,
To the best of my knowledge, there are very few, controlled studies of the efficacy of
oral motor exercises in speech remediation. The studies that I know of are quite old.
They include: Overstake, C. (1976). Investigation of the efficacy of a treatment
program for deviant swallowing and allied problems, part II. Internl J Myology 1976;
2:1-6.
Christensen, M. & Hanson, M. An investigation of the efficacy of oral myofunctional
therapy as a precursor to articulation therapy for pre-first-grade children. J Speech
Hear Dis 1981; 46:160-167.
Dworkin, J.P., Abkarian, G.G.., Johns, D.F. (1988). Apraxia of speech: the
effectiveness of a treatment regimen. J Speech Hear Dis 1988; 53:280 94.
There are some related studies from the dental literature in which jaw exercises were
implemented.
Would it be true to say that there is more efficacy data for OM exercises in dysphagia
tx than in non-dysphagia related tx?
Debra Beckman Debra Beckman - 08:12pm Sep 23, 2003 EST (#76) {Bookmark}
Here is one of the most recent articles re: oral motor interventions and tube to oral
transition:
Journal article citation: Oral Stimulation Accelerates the Transition from Tube to Oral
Feeding in Preterm Infants, by Sandra Fucile, Erika Gisel, and Chantal Lau, Journal of
Pediatrics, Volume 141, Number 2, pages 230 – 236.
I think that if you want speech to change, you work on speech, not on things that

appear to be related to speech.
When practicing piano, a person will practice playing music, not practice fingering on a
counter top to pertend they are playing the pianio. If you want speech to change, work
on speech!
I believe the efficacy reviews we have posted are more general, but perhaps Joanne
can speak to the swallowing issue? My memory of the Bells Palsy literature is that
behavioral intervention paired with appropriate medical treatments (e.g., steroids)
speeds acute recovery, but I'm afraid I know less about chronic Bell's Palsy.
One might be tempted to try e-stim, but I am more familiar with that literature, and
the data has been largely unimpressive, and e-stim may even have unintended side
effects (e.g., synkinesis)
thanks for responding, i dont know of any norms either. does anyone continue to work
toward improving facial symmetry once speech intelligibility is WFL? (and of course
deglutition is functional ie, no antreior loss)
Heather,
you made the point I wanted to bring out about ROM... it can be affected by a number
of variables and strength is only one of them.
Jay
I'd like to respond to Greg's comment, pointing out a key philosophical difference
(perhaps contributing to the controversy around these techniques).

On the one hand, some clinicians feel that it is most appropriate to direct treatment at
the functional behavior (if speech is the problem, have the patient do speech - see
Greg's comment). On the other hand are the clinicians who reason that, if underlying
motor deficits are contributing to observed speech or swallowing dysfunction, directing
treatments at alleviating the underlying impairment may improve speech and
swallowing.
Anyone have additional thoughts about philosophy?
Kim Ward mcav0y - 08:19pm Sep 23, 2003 EST (#82) {Bookmark}
Dr Lof,
What is your view on using OME with children who have sound sequencing difficulties
or apraxia of speech? Has there been any research conducted in this area?
Karen Brown Karen Brown - 08:19pm Sep 23, 2003 EST (#83) {Bookmark}
Just so that we're all on the same page, maybe Joanne would define efficacy and
explain the difference between efficacy and effectiveness.
Jay,
ROM and strength are related. It is difficult to maximize strength for striated muscle
fiber if range is limited. Typically, I try first to work for range at minimal competencies
before focusing on movement against resistance to build stength.
Lisa Sokoloff LisaLisa - 08:21pm Sep 23, 2003 EST (#85) {Bookmark}
Jay & Heather, you make a good point. Many of my patients have Parkinson's disease,
PSP, CBGD, etc and rigidity is a huge factor in their ROM. This significantly affects
speech and swallowing. However, I find that exercises are often fatigueing and not that
effective.

Lisa
PS - Hi Heather, from Toronto
i too would like to hear about techniques people have found to be effective with
velopharyngeal insufficiency, at times this particular deficit seems to have so great an
impact on overall intelligibility, but i find it hard to target directly
any ideas?
Greg,
thank you for saying what a lot of us believe intuitively, even without any literature
support. Speech is series of a gestural events that require coordination of respiration,
phonation, velopharyngeal and oral articulatory functions. Simply working on oral
motor exercises words the necessary coordination of the other subsystems.
Jay
Jessica,
The patient's goals are important to bear in mind. While as the clinician, I am most
interested in restoring swallowing function and facilitating improved speech
intelligibility, if the patient's goal is to achieve improved facial symmetry, then I refer
to a wonderful occupational therapist here at Univeristy of Wisconsn named Jackie
Diehl. She has a specialized neuromuscular clinic for facial paresis and has wonderful
outcomes. You may with to follow up directly with her on her methods. She has
published but more along the line of her methods and case reports - no clinical trial
data.

Fran,
Only minimal strength is needed for speech. The estimate is only about 3% of possible
strength is needed in the oral area for function. That is why attaining even minimal
competencies may produce improve control. Striated muscles change in levels of
activation through the day for normals, that is why muscle averaging is not the best
way to determine cometencies.
In response to Heather's qustion about additional philosophical thoughts - I agree that
in many cases there may be underlying deficits that need to be addressed. My concerns
are determining 1) if there are underlying deficits that are impacting speech and 2)
what are the best procedures for altering the function for speech. Task specificity is a
big issue in motor behavior, in general, so the treatment target probably needs to
include the same complexity and organization as speech. I wonder, once you consider
task issues, what is an efficient use of treatment time - determining exercises that may
mimic the complexity of speech or just using speech? Again, I think that these are
questions that need to be addressed empirically.
Caroline Bowen Caroline Bowen - 08:24pm Sep 23, 2003 EST (#91) {Bookmark}
I run a listserv http://groups.yahoo.com/group/phonologicaltherapy/in which 970+
participants discuss child speech research, development, disorders and intervention.
Most participants are SLPs or Linguists.
Just to declare my hand - I am NOT an "oral motor exercises" person when it comes to
functional speech disorders. But many on the listserv are devotees.
There are several issues that I have never been able to have answered satisfactorily.
People post to the list that they ASSESS thoroughly for "oral motor weakness". How
are such assessments executed? What do you actually look for?
People post to the list that they work on "oral motor" as a preparation for traditional
articulation tx, or phonological tx. Why?
SLPs working with special education populations appear to be particularly adamant that
oral motor work is an essential component of therapy for speech sound disorders.

What concerns me about all of this is the lack of scientific references to support these
strongly held views, and the tendency to quote "gurus" who promulgate an oral motor
approach as the way to go.
Caroline
Jessica,
From a physiologic perspective (and with some data to back it up), Kuehn and
colleagues' use of CPAP to provide resistance to the VP musculature during speech
movements seems right on!
Kuehn, D. P. (1991). New therapy for treating hypernasal speech using continuous
positive airway pressure (CPAP). Plastic and Reconstructive Surgery, 88, 959-66.
I was asked what I thought about OME with DVD...these kids seem to be the WORST
case for these exercises. By definition, these kids will need to have speech worked on
because they have speech sequencing problems. Working on things that are not speech
related would not help. If they had oral apraxia, then MAYBE OME MIGHT work, but if
they have VERBAL arpraxia, then work on the verbal.
Michael Hammer mhammer - 08:25pm Sep 23, 2003 EST (#94) {Bookmark}
To add to Dr. Clark's comments, there is at issue whether the non-speech treatment
elicits movement/behavior which are really reflective of those required during speech.
As Dr. Forrest's handout indicated, the forces generated during speech production are
much smaller than the maximum effort tasks which are frequently employed in
treatment. Any further comments?

thank you joanne
i will take down her name and see what i can find
Alicia Multari aliciaslp44 - 08:26pm Sep 23, 2003 EST (#96) {Bookmark}
What about OME with the birth to three population who are presenting with low tone,
reduced babbling and texture/taste aversion to certain foods? Has the literature
supported using OME with this specific population?
Karen,
Efficacy is defined as change from intervention assessed in ideal circumstances and
effectiveness is change assessed in routine circumstances. These are rough adaptions
from Randall Robey's publications - by the way, he will be presenting at the NIH pre-
ASHA program on Monday/Tuesday in Chicago in November. A great person(thinker) to
read or hear....
The face represents a dynamic web of fibers. The interactions between muscles and
structures vary tremendously. In working with any part of the oral musculature, all
parts are impacted. It is not really possible to isolate parts from the whole.
Jessica,
Velopharyngeal incompetence is a broad disorder. Severe velopharyngeal
incompetence will require some type of physical management (surgical or prosthetic.)
Small VPI's might be addressed with therapy. Dennis Ruscello from West Virginia has
an excellent chapter in the Bzoch textbook "Cleft Palate Speech" in which he reviews go
to literature in this area.

David Kuehn and Jerry Moon demonstrated that the amount of velopharyngeal
elevation is directly related to oral pressure for blowing tasks. Velopharyngeal
movement for blowing and speech are very closely related and clinically we certainly
see increased soft palate elevation when someone over aspirates pressure consonants.
GM Gabrielle - 08:30pm Sep 23, 2003 EST (#100) {Bookmark}
If oral motor exercises are not useful, what do you do for kids who absolutely cannot
put or keep their tongues in the right position for /s/, /r/, /ch?, etc.
I am in agreement for the most part about abandoning OME except for the kids who
cannot seem to elevate or tense their tongues adequately to make certain speech
sounds...What do you attribute their difficulty to?
GM in Boston
To reply to Caroline,
My impression is that many times strength is inferred from symmetry and/or ROM (and
as Jay highlighted, this may not be a valid inference).
Some commercial devices are available for objective measures of strength (particularly
tongue strength - see Joanne's paper earlier in the discussion). However, when those
aren't available, the standard "oral motor exam" may provide pretty useful information
(see ref below).
Clark, H. M. , Henson, P.A., Barber, W. D., Stierwalt, J. A. S. & Sherrill, M. (2003).
Relationships among subjective and objective measures of tongue strength and oral
phase swallowing impairments. American Journal of Speech-Language Pathology, 12,
40 - 50.
Erin Dyer Olson Erin Dyer Olson - 08:31pm Sep 23, 2003 EST (#102) {Bookmark}
In my district, the OTs do a lot of oral motor work on students with Dyspraxia and
Dysarthria. What kind of research has the OT profession contributed as far as the use

of OME?
Karen Karen115 - 08:31pm Sep 23, 2003 EST (#103) {Bookmark}
Hi from Karen in Rochester, NY:
Is it not possible to assist a client in becoming more aware of his articulators through
warm-up exercises, so to speak, that facilitate correct productions; especially
considering the number of children being diagnosed with sensory difficulties along with
artic issues?
Tone is determined at the central nervous system level. However, many people use the
term tone when they actually mean muscle strength, the ability of the muscle to
activate to meet the work load of the task at hand, whether that is a speech or non
speech activity.
Renee Hill oromotorre - 08:32pm Sep 23, 2003 EST (#105) {Bookmark}
In response to the question about velopharyngeal insufficiency, Sara Rosenfeld-
Johnson has developed a technique called "Oral-Nasal contrasts" which isolates the oral
component and the nasal component in speech production. The complexity of the task
increases with success. The success in my experience has been based on the ability to
establish oral airflow and nasal airflow independently through a hierarchical oral-
exercise approach prior to introducing the speech task.
Cheryl Harding Cheryl Harding - 08:33pm Sep 23, 2003 EST (#106) {Bookmark}
I have a dear friend whose mother was recently diagnosed with ALS. She has not had
very much luck in finding an SLP experienced with this condition. Any ideas about
research or SLPs experienced with ALS? (This woman lives in Texas, but would be
willing to travel, especially to the Chicago area.)

Mike,
Yes, Karen's work does indicate that speech requires sub-maximal pressures, quite
small. Our work is indicating that while swallowing also requires sub maximal pressure
generation, functional swallowing requires GREATER pressure than does speech
production. The requirements,in terms of maximal pressures, increase depending on
the viscosity of the material being swallowed (e.g., thin liquids do not requitre as much
strength as do more viscous or solid foods and so strengthening exercises may be
useful in the swallowing realm.
thanks heather
how is cpap applied, i have only heard of this term in regards to ventilator settings
thank you john
i will definitely try the overaspirating pressure consonants the next time the issue
comes my way
how wonderful to have access to all of your brains!
Billy Irwin Billy Irwin - 08:35pm Sep 23, 2003 EST (#109) {Bookmark}
Please comment on the fact that there is very limited evidence to support OMEs for
specific deficits and that there seems to be a gap in the literature between improving
strength and ROM (the targets of OME tasks) and speech and swallowing deficits. Is
there someone out there who has some data to make this less of a leap?
Gregory,
Most athletes will tell you that cross training, working on many associated muscle

activities, improves the control needed for specific activities. For example,
strengthening upper body aids in improving aim and coordination for golf or tennis. But
in addition, one must indeed practice the specific movements for the target tasks. I see
specific oral motor interventions focused on improving minimal competencies for range
and strength as one part of a complete program for an individual who is not
progressing with traditional "listen and say" interventions.
Barbara Buwalda Barbara Buwalda - 08:36pm Sep 23, 2003 EST (#111) {Bookmark}
Debra Beckman,
What makes your protocol different from other OME like blowing toys and such
Debra,
Thanks for your comment, I think muscle tone is poorly understood by SLPs. As you
say, the CNS contributes greatly to tone, as do some peripheral reflexes (e.g., stretch,
tonic vibratory).
I believe some oral motor treatments are purported to target muscle tone, by
stimulating the muscle spindle (which respond to changes in muscle fiber length).
Many of us need to be reminded that many muscle groups we work with don’t have
muscle spindles, or the spindles don’t elicit reflexes in the same way as muscles in the
limbs. The lips, tongue, and jaw opening muscles are examples. Only the jaw closing
muscles have muscle spindles and stretch reflexes like the limb muscles.
Gabrielle,
It sounds as though you have used OME for children who can't get adequate muscle
tone for consonants. Can you give us some indication of the effect of these exercises
on the children's speech? That is, can they produce the sounds after the exercises?
We have been investigating this issue and have not had much success. That is, we use
OME with children with multiple speech sound errors and due extensive probing of their
production of the target sound in words. We have not found any increase in the

production of the target sound after many weeks (up to 8 weeks, now) of OME. This
research is ongoing so there haven't been that many subjects yet. I'd be interested to
hear of other people's experiences.
How does one know what specific oral/lingual exercises to work on to help someone
swallow material with greater viscosity?
Given several comments here tonight, it appears that there is evidence (or at least a
good hunch!) that integrating behaviors gives you more performance change than
isolating them. In LSVT the treatment focused on increasing voice loudness but not via
respiration exercises. In recent aphasia literature, isn't there a move toward integrating
verbal and written expression tasks, for example? Perhaps the same in true for OM
function????
When working with a patient for whom OMEs make sense, do you usually provide
instructions and train the pt. to perform these outside treatment time? It seems that
the pts who will benefit from OMEs will be the Pts with the cognitive ability to perform
and monitor performance independently and frequently, and not the pts who only
perform the OMEs in the presence of the clinician. Ms. Beckman, could you respond?
I am NOT a VPI specialist, but my latest review of 30 years of literature seem to
support that the VP complex can be strenghtened by blowing exercises....but there will
still be speech problems. Same structures are used for differnt functions. Strengthening
the VP complex probably will not lead to better speech productions.

Hi Billy (from down the hall!)
I believe that the data just aren't out there. But I'd like to offer some suggestions
about WHY they aren't out there (in addition to the obvious, which is that maybe there
is no benefit). Many researchers are philosophically opposed to motor treatments (see
earlier comments) and are thus disinclined to study their effects. The fact that many
popular treatment programs lack clear theoretical foundation further complicates the
issue – it is difficult to develop the rationale for a treatment study incorporating such
treatments. Perhaps even more troubling is the lack of standardized measure for many
motor function characteristics (e.g., muscle tone) so that it is difficult to identify key
outcomes. Not to mention, treatment research is slow and costly. Taken together, it
may be more surprising that there are ANY studies out there at all!
GM Gabrielle - 08:42pm Sep 23, 2003 EST (#119) {Bookmark}
Karen,
I use OME as a LAST resort and I have actually had little success with it (for functional
articulation errors). I cannot figure out though, what accounts for these kids inability to
make the sound if it isn't some difficulty with some aspect of the oral motor system....
Gabrielle
Barbara,
The difference between Beckman Oral Motor and other oral motor strategies is two
fold. First, there is a quantified baseline protocol to determine minimal competencies
for range and strength for the lips, cheeks, jaw, tongue and soft palate. This protocol
uses assisted stretches and stretch reflexes, so that cognitive participation is not
required, although this protocol can be used with individuals who do follow commands.
The baseline information is function specific, not age specific. Second, the interventions
are assisted stretches, and do not required expensive equipment or kits of materials to
provide the movement. The interventions can be combined with other modalities or
activities to enhance muscle skill development. The strategies used are muscle

compression before elongation, assisted movement to activate contraction, contraction
against resistance to build strength, slow movement, muscle deep pressure, slow
movement and movement toward midline.
andrea,
it would seem to me that "effortful swallow" would be most helpful and perhaps base
of tongue to posterior pharyngeal wall, trying it out myself as i type perhaps producing
saliva swallows with lips parted is another way to force greater tongue pressure
just some thoughts - no research involved
Andrea,
We don't have enough evidence eyat to directly recommend specific exercises to
improve swallowing specific viscosities. However, we are conducting a clinical trial now
and our data thus far are compelling with regard to the consistent findings of
improvements in lingual strength with lingual resistance exercises and our patients'
reprts of diet expansion/upgrades associated with those outcomes. Our data analyses
are also revealing that the strengthening exercises not only result in incresased
strength but also faster pressure building. We are pursuing the relationship between
strength training and changes in coordination. A finding of improved coordination from
resistance exercises would be most wonderful for our patients but we haven't
determined that yeat with enough patients. It's still a hypothesis we are testing.
Licia Coceani Licia - 08:45pm Sep 23, 2003 EST (#123) {Bookmark}
Hi Caroline,
Did you have the chance to read some of the articles published in the International
journal of Orofacial Myology? There are several studies regarding oral motor exercises
and their efficacy in different populations and different age range.
Ciao from LA

Billy, I know of at least one case study (see below) where the client completed tongue-
strength training outside of treatment, with clinic treatment comprised of performance
level targets (I hope I'm not in error about these details). These authors reported
success.
Solomon, N. P. & Stierwalt, J. A. G. (1995). Strength and endurance training for
dysarthria. ASHA Special Interest Division 2 Newsletter, 5 (2), December, 1995. 13-
16.
Sandy
Wonderful observation. Monica McHenry (American Journal of Speech Language
Pathology year?) Demonstrated that nasality was decreased by increasing loudness in
speakers with dysarthria. I think the results of her investigations, Moon and Kuehn and
the Lee Silverman technique have a similar theme. Increasing/improving speaking
effort improves function across-the-board.
Billy,
I include the caregivers as well as the individual, since many of the individuals on my
case load cannot provide their own practice in movement. I agree that small amounts
of movement through out the day, whether speech practice or oral motor practice is
more desirable than long segments of time, which may result in fatigue, rather than
improved control.
Roberta Wacker Mundy Roberta Wacker Mundy - 08:48pm Sep 23, 2003 EST (#127) {Bookmark}
I've been thinking about Greg Lof's comparison to playing the piano. My piano teacher
always had us practice the scales before each lesson and each practice session. I
believe that was because it tended to get our fingers moving in the way they would
need to to play a song since the movement of the fingers for playing the piano is

different than the movement for other activities. We didn't move our fingers and
pretend to play the piano, but we did move our fingers up and down the keyboard in
such a way to simulate piano playing and "warm up". Also, this (I assume) helped us,
and our fingers, to "remember" the movement pattern. So, what does this mean? I
guess that it appears that, using this analogy, working on the specific movements that
need to be made for the production of (a) particular sound(s) could be effective. But
practicing unrelated oral movements (movements that are not important for the
production of particular sounds) would not be.
Gabrielle,
That's a good question! First, I'd like to know if the problem really is tongue position.
We have seen some children, and adults, who have incredible difficulty with some
sounds and when we measure things like nasal or glottal airflow, we find some
problems. We worked on airflow with a flow feedback protocol (AEROwin) and had
some success. I want to emphasize that these were not controlled investigations in any
way. Perhaps Jay can give more insight into this possibility - i.e., sound specific VP
problems?
Gregory,
You are exactly right. It seems, that the focus should be on increasing respiratory
support (possibly first for blowing) but transitioning quickly to increasing respiratory
support for the aspirate consonants.
Janice Flanzbaum J.Flanzbaum - 08:50pm Sep 23, 2003 EST (#130) {Bookmark}
Hi, Janice Flanzbaum from Pleasanton, CA and an Indiana University Alum
Renee posted mention of Sara Rosenfeld-Johnson's program. I wonder what the group
thinks about the effectiveness of straws and horns for improving tongue retraction and
for OME.

I agree strongly with Sandy (and Greg indirectly). OME might be useful although one
should know exactly why they are doing a specific exercise. However, integration of
OME into a function is critical.
Dr. Clark--what does 3% of possible strength actually mean? It sound quite minimal.
I typically hear from proponents of oral motor exercises that nonspeech movements
must be learned before speech movements can be learned. I would like to point out
some research from Chris Moore and his colleagues that demonstrate that the motor
movements they investigated (mandible and lip) developed in parallel not in sequence
and seemed to be mediated by different control mechanisms.
References below the 1997 article is posted here.
Moore CA, Ruark JL.
Does speech emerge from earlier appearing oral motor behaviors?
J Speech Hear Res 1996 Oct;39(5):1034-47
Ruark JL, Moore CA.
Coordination of lip muscle activity by 2-year-old children during speech and nonspeech
tasks.
J Speech Lang Hear Res 1997 Dec;40(6):1373-85
Janice,
I'll let Karen or Jay comment on the specifics, but from a purely "rationale"
perspective, blowing and sucking are, in themselves, complex movement patterns that
AREN'T SPEECH! Therefore, principles of motor learning would not predict that tongue
retraction displayed during blowing/sucking would necessarily generalize to speech
movements.
In fact, if benefit is observed, it would be more easily explained from a sensory
awareness perspective (can you feel how your tongue is shaped?) than from a motor
program explanation.

Joanne,
I'm glad this type of research is ongoing. We used to do oral motor exercises all the
time for oral dysphagia, then we stopped altogether when we became aware that there
was no evidence-base for it. But I suspect the "truth" lies somewhere in the middle -
there are probably specific exercises which will help specific deficits... we just don't
know what they are yet.
Carol Healy Carol Healy - 08:57pm Sep 23, 2003 EST (#135) {Bookmark}
I have a 2 year old that I have just started to work with that is non-verbal, using ACC,
had gross motor involvement and self stims with arm movement. He also grinds his
teeth, which I also feel is self stim. Any suggestions for the teeth grinding?
Bellingham sharlaurie - 08:57pm Sep 23, 2003 EST (#136) {Bookmark}
Roberta that was a good point. I have had excellent success in teaching children to
make an /f/ by having them practice biting on their bottom lip repetively to retrieve a
cheerio. We practice that movement first then we add the sound. I have found this can
work better than just asking them to make the sound because then they produce the
error sound. I think practicing the movement they will need to produce can help. I
don't beleive in using just oral motor techniques without speech. When a child can not
make a sound you have to find away to help them to learn to do so.
Joann Smithpeter Joann Smithpeter - 08:57pm Sep 23, 2003 EST (#137) {Bookmark}
Orofacial myology is used daily in our office. We see incredible results. As Licia
mentioned above, the International Journal of Orofacial Myology has published several
articles on the efficacy of this treatment.
Kay Jellison

Gayle Merrefield Gayle Merrefield - 08:59pm Sep 23, 2003 EST (#138) {Bookmark}
I have used Beckman's oral motor protocol for several years, and it has become an
important component of my assessment and treatment. I end up with excellent
baseline data against which I can measure change over time. It is not the only aspect
of treatment I provide (my caseload is mostly preschool), but correctly applied it
certainly yields physical and functional changes.
Alesha & Amy aheafner - 09:00pm Sep 23, 2003 EST (#139) {Bookmark}
We are graduate clinicians in the ASU CD program. We have been in practicum settings
where one supervisor is totally against oral motor exercises in relation to speech and
another supports oral motor exercises for the remediation of articulation insufficiencies.
Given these opposing views and our lack of experience it is difficult to determine
whether oral motor should be used. Presently (under strict supervision) we are trying
to decide whether or not to incorporate oral motor exercises to address a lateral lisp
and to remediate the /r/ sound.
Fran,
I'm not sure if there was a typo - the range of force used during speech movements
that I've read is usually around 20%, give or take.
These figures, of course, were developed from instrumental measures, not subjective
judgments, so it's hard to translate that into "meaning" (e.g., what does 20% "look"
like?)
I alluded to this before, but minimal competence (to use Debra's term) for FORCE is
surely well below "normal" maximum, however, some authors (e.g., Erich Luschei)
argue that strength may be necessary to move the articulators (especially the tongue)
quickly. This remains an empirical question.
Billy Irwin Billy Irwin - 01:39pm Feb 27, 2003 EST (#141) {Bookmark}

Joann,
Do you have any references handy for the efficacy of orofacial myology treatment. And
exactly what does that involve? Is it a specific protocol or program of treatment?
Marlene Pettiford mapslp - 09:00pm Sep 23, 2003 EST (#142) {Bookmark}
Heather, I would agree with your observation. In my experience, I have always felt
that improvements in speech movements that I occasionally see in my therapy using
OME (ie. blowing, sucking) are a result of increased sensory and proprioreceptive
abilities.
Jodi Mitchell Jodi Mitchell - 09:01pm Sep 23, 2003 EST (#143) {Bookmark}
What about back sounds such as /k/, /g/ when a child (kindergarten age) cannot lift
back of the tongue? Maturity? I don't think so.
I appreciate everyone's input. This is very helpful to each of us in deciding our
treatment and especially our REASONS behind it.
Andrea,
I posted the citation regarding tube to oral transition with preemies using specific oral
motor interventions that did show a significant improvement in the group receiving the
interventions as compared to the group that did not. I agree with you that an all or
nothing approach to oral motor will probably not be helpful. We do need to continue
research to find out the specifics for different populations and different areas of
impaired function for those populations. The interventions used should be prescriptive
and fit the need of each person. Is ASHA currently funding research projects regarding
this topic?

Janice, let me begin by citing the Evidence Based Medicine (scores)
• 1- Randomized Control Trial
• 2- Prospective Cohort
• 3- Retrospective Review
• 4- Case Series
• 5- Expert Opinion
I am about to give you a number 5. When trying to modify tongue position I start with
a speech sound it already has the correct position and 10 modify the production to the
desired sound. For example, the "s" is interdental-or lateralized let the "t" is post
dental and central. Simply prolonging the "t" will generally produce a post dental and
central "s". But, notice I am using the motor plan of one speech sound to create
another. Now, with that said did I understand the question correctly?
Jay
What about back sounds such as /k/, /g/ when a child (kindergarten age) cannot lift
back of the tongue? Maturity? I don't think so.
I appreciate everyone's input. This is very helpful to each of us in deciding our
treatment and especially our REASONS behind it.
hello - I had a question regarding bottles and pacifiers- was looking for some
suggestions to decrease/ eliminate their use. I have 2 little girls with significant open
bites, drooling, om posture and severe articulation deficits. One is on a bottle and the
other a pacifier. thank you!!
it would seem there is need for OM in oral dysphagia, but this can be done in functional
methods. one particular that i often employ is chewing ona straw anbd having the
patient lateralize it to each side using tonue (no hands)while keeping lips tight emough
to prevent straw or saliva from leaking out.

Alesha and Amy,
I sympathize with your situation. I have spoken with a number of our previous students
who have been asked to do OME in their clinical externships. It really does put the
student in a very awkward position. You may ask your supervisors to provide some
references to help you get an idea of their perspective and why they want you to do
OME. In general, the protocols that I have looked at suggest OME and then "traditional
speech therapy." Because speech therapy also is included, it is difficult to determine if
changes were because of OME or speech treatment.
Regarding k and g, I often use a non food item between the molars on one side or the
other to enhance posterior tongue elevation as I cue for production of h, with high back
vowels to get k or g in isolation, then work to get the same production with no tactile
cue, and on to production a rapid syllable and then to word and phrase production.
Andrea,
Thanks for the encouraging words. We are imaging muscle with magnetic resonance
and are finding that msucle mass in head and neck (e.g., particularly tongue)
diminishes with age just like we all know that limb musculature diminishes with age. So
exercising head and neck muscles may be particularly justified and beneficial in elderly
individuals. We are quantifying outcomes including strength and muscle mass and are
pleased to find, thus far, a positive relationship between the two. Our hope is to
determine if strengthening exercise will, in the long run, prevent reductions in muscle
strength and mass - so well documented in limb musculature of older individuals. The
effect such intervention has on swallowing is promising but not shown convincingly as
of yet.
I agree with you, it is important to have a justification for the specific exercise we have
patients do - I have seen lots of lingual protrusion exercises being done by clinicians
and wondered what functional application such a task has for swallowing (or speech).

Jacquelyn Fowler Jacquie F. - 09:07pm Sep 23, 2003 EST (#152) {Bookmark}
Similarly to Gabrielle...
What about those children for whom they have a difficult time with tongue protrusion
and tongue movements (anterior and posterior). If they have a difficult time moving
their tongue on command, how do you teach them tongue placements (especially for Ll
and Rr) without doing some sort of oral motor/tongue exercises, so they know where
their tongue is in space??? Any suggestions.
P.S. Hi Karen from Rochester.
I have strictly empirical data suggesting that for some children with limited lip and
tongue control/awareness, doing 5 minutes of "warm-up" exercises that raise the
metacognitive and sensory awareness can assist in the production of sounds...this is
not the focus of the intervention...speech is the focus...I agree with the readings
suggesting limited, targeted and careful use of the OME
Jessica,
What do you do for the individuals that cannot follow commands?
I can't believe or understand how anyone can not agree that we use the same muscles
for speech and non-speech movements. I have found that many of my client's with
speech disorders also have difficulty with non-speech and feeding activities. If a child
cannot blow a horn without compensating for the lack of strength in the target muscle
group (ex. lip closure on a mouthpiece without biting for support) and I see that the
same child cannot make a specific sound with that same muscle in deficit (bilabials),
why is it so difficult to believe that if I target the muscle outside of speech, it will
improve their production.

Karen, I would LOVE to have the reference to the empirical data you mentioned about
OME and warm-ups. My review of the literature has not turned up any such published
articles, so I would be excited to review these data.
Alesha & Amy aheafner - 09:12pm Sep 23, 2003 EST (#157) {Bookmark}
Thanks, Karen, for the advice. : )
Kelly Lynn Guilmette kguilmette - 09:14pm Sep 23, 2003 EST (#158) {Bookmark}
Back to OME with the Birth to Three population. I too am looking for opinions and
research to back up OME exercises with children who have low tone, specifically Down
Syndrome. Thanks!!!
Thank you Debra for the information. And thanks to everyone for their input tonight.
Passive treatments and physical modalities:
This is a follow-up to Debra's question about what to do when a patient can't follow
commands. Often passive treatments or physical modalities are recommended in this
scenario.
The trick is recognizing which of these strategies are applicable to the orofacial
musculature, given the lack of the muscle spindles/stretch reflexes.

Quick stretch, tapping, and vibration all act on the muscle spindle and therefore would
not be expected to impact tone of the lips, tongue, face, or jaw opening muscles.
Some modalities that MAY have application in the musculature of interest are:
Heat elevates the threshold for pain so people can move farther (increased ROM)
without pain. The most obvious application of this technique would be for people with
severe TMJ or pain related to cancer resection.
Cold decreases nerve conduction velocity and is traditionally used to relieve spasticity.
It will probably be most effective for muscle groups with stretch reflexes (jaw closing
muscles). Remember cold is also used to heighten sensitivity of touch receptors (e.g.,
thermal stimulation for swallowing) but this is separate from the effect of cold on the
neuromuscular system.
Massage has a relaxing effect on muscle activity. It is used to reduce hypertonic or
non-organic hyperfunction (e.g., functional hyperphonia). It would be expected to work
similarly on all muscle groups, but the few studies that have been conducted have only
examined effects on laryngeal muscle groups.
Meredith Meredith - 09:17pm Sep 23, 2003 EST (#161) {Bookmark}
I've had no trouble teaching central air flow for a lateral lisp, r position or any other
position without the use of nonspeech OME. I've found using visual cues, some tactile
feedback, shaping from other speech sounds, using minimal pairs/contrast, achieving
the sound contextually, etc have been more than sufficient to remediate articulation
and phonological errors. Even in a child who has never produced a k or g volitionally,
(nonpeech) OME would not be my choice.
Denise Ruscio Russpeech - 09:18pm Sep 23, 2003 EST (#162) {Bookmark}
Regarding the strategy of placing the cheerio on the lower lip to facilitate a "precursor"
motor act to production of / f /, I'm assuming you're holding the cheerio, and it's
placed centrally on the lower lip, correct? Ever used mini m and m's for this? Also, I
had a question with a phonological basis, although I recognize this forum is focusing on
oral motor issues. Thought I'd take a chance! What strategies would you recommend
for a 4 yer old child who is producing stops for fricatives?

Renee,
I would agree with you that children with a deficit in one function often demonstrate
deficits in other behaviors. And, very often, a person who has a severe disability in one
area (e.g., speech) will also have a severe disability in another area (e.g., feeding,
walking, handwriting). It's very hard to make causal relations when you are looking at
correlations. I think that that's part of the difficulty that we have in researching this
area.
I think part of the effectiveness of oral-motor therapy IS that it increases sensory
awareness. Especially with the Apraxia/Dyspraxia population. Oral-motor therapy is
tactile and gives information to the brain in a different way. If the child isn't following a
verbal or visual cue, why not give them a tactile cue of what you want them to do. Isn't
that another way of developing the new motor-plan for a movement. Then I can add
the voicing to the tactile cue and eventually remove the tactile cue all-together. Isn't
that "oral-motor therapy"?
Aileen,
How old are those children? I'm not sure what you mean by suggestions for getting
them off the bottle/pacifier.
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topic created 11 Sep 2003 by sysop
NOTE: This discussion is now a read-only archive. Members who wish to continue this discussion
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Discussion area here on the Member forums.
Straws and whistles, bite-blocks, nuk brushes, sensory and motor stimulation -- the list of oral
motor treatments goes on. Do they work? How do they work? When do they work? How do you
know if they worked for a specific client? A panel of experts helped members explore these
questions on a Web forum held September 23, 8-10 pm, ET. The event was sponsored by Special
Interest Divisions 1 (Language Learning and Education), 2 (Neurophysiology and Neurogenic
Speech and Language Disorders), 4 (Fluency and Fluency Disorders), 5 (Speech Science and
Orofacial Disorders), 13 (Swallowing and Swallowing Disorder), and 16 (School-Based Issues).
DISCLAIMER: All comments are the opinions of the individuals who took part in this Web forum
and do not necessarily reflect the official opinion of the association, nor does a mention of a
commercial product here imply a recommedation for such a product by the association.
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Hi Kelly,
I would like to add one observation in response to your question. Children who appear
to have low oral tone- open mouth posture and tone forward may be doing so to
maintain a patent oral airway because of nasopharyngeal obstruction. Again this is only
expert opinion that we routinely see children with swallowing problems or diagnoses of
"weak" oral tone who actually have Nasal/nasopharyngeal obstruction.
Heather,
I find that many therapists use the terms stimulation and intervention interchangeably,
but they are diffent in impact, as you point out. I would define quick stretch, tapping,
vibration, heat, cold and e-stim as stimulation modalities, not interventions, that
should be followed by work for the muscles (interventions), either assisted movement
or active patterns (eating, talking).

Renee,
I think the explanation comes primarily from an understanding of motor learning and
motor unit recruitment. The brain learns to recruit the appropriate motor units needed
for a specific exercise, so part of the "strength" gained during exercise is from the
brain knowing better how to get the muscle to contract. If the target movement
outcome doesn’t match the exercise, the brain hasn’t learned that recruitment pattern,
and won't necessarily be "stronger" for that movement.
However, Joanne's research showing changes at the muscular level provides some
hope that muscle fiber hypertrophy can also occur, which has more general effects (at
least that's the case in the limb musculature). We'll await her findings.
hello Denise- I have found working on s blends successful for these children since they
just need to add a fricative to a stop and them they may get frication with other
sounds. "Targeting intelligible speech" is a good resource
Janice Flanzbaum J.Flanzbaum - 09:21pm Sep 23, 2003 EST (#170) {Bookmark}
Jay
Using the 't' context to motor plan for the 's'seems to work in isolation yet carryover is
difficult. So, I wonder if tongue retraction exercises i.e. straw drinking would have the
same effect as multiple repetitions of the 't' sound. The 't' method is blowing out air as
we do with speech the straw method uses muscles for sucking.
Licia Coceani Licia - 09:21pm Sep 23, 2003 EST (#171) {Bookmark}
For Carol Healy
I recall a study by Dr. Lefebvre (spelling?) pointing out that teeth grinding (bruxism) is
a central problem (nervous system) and not a peripheral problem (malocclusion) as

thought for a long time. Still, it's a big problem. I don't know if bruxism in a two-year
old child is self stimulation, but maybe an experienced orthodontist, one that treats
children with neurological dysfunctions, may be able to help you. Maybe a mouthguard
or something similar?
Heather,
Do you know what research ASHA is currently funding regarding efficacy of oral motor
interventions and speech?
Thank you Karen, I just really think it's disheartening to hear so many people in our
profession who sound "close minded" in my opinion to the possibility that there are
actually "oral-motor programs" that are actually working. I also find it sad that
colleagues who have looked into doing this reasearch as dissertations for phD's have
been rejected because of the controversy. Isn't it safe to say at this point that we
SHOULD be doing the research BECAUSE of the controversy? Unfortunately, most of us
out there are simply "therapists" who just want to provide the best therapy we can.
Why aren't (or can't) the researcher's do more to find out why there are so many of us
who are saying this is working?
Debra,
Thank you for that clear response highlighting the difference between sensory and
motor effects. Again, I'm not sure most SLPs are as confident in differentiating targets
(sensory awareness versus neuromuscular integrity) given the same procedure (e.g.,
tapping).
It seems to me that most SLPs lack foundational knowledge about how motor
treatments are intended to impact the motor (or sensory) system . Our textbooks and
training programs do not generally include even the theoretical foundations for motor
treatments, so clinicians have very little information on which to base judgments about
whether specific treatments even make sense. This is unlike our preparation in other

treatment areas, where theoretical models of intervention are discussed in detail so
clinicians can evaluate specific programs for theoretical soundness.
Bellingham sharlaurie - 09:25pm Sep 23, 2003 EST (#175) {Bookmark}
Hi Denise, I find working on fricatives in the final position first then using a paired
stimuli approach for example. "Ice"..."e". I use alot of silly visuals to make it fun. I
have used this approach with many children aged 3 to 5 with great success. Hope it
helps.
Renee,
I don't consider tactile cues to be in OME if they aren't done "drill like" (lots of tongue
tickles just for sensory input). I give tactile cues at times when teaching a placement
(esp for R) but don't teach repetitive nonspeech movements or spend time
stimulating/stretching articulators. I find mutimodal cues to be very necessary, but
don't find nonspeech movements to give as much feedback as my tactile cues to lips,
tongue, etc.
Janice,
You are right if you only work on single words-I should have finished my thought. This
is incorporated into the traditional therapy process. Progress quickly to carrier phrases,
etc. we also review the family's daily routine so that every pair of "Sox", every "stop
sign" is a therapy opportunity-that is therapy is done throughout the day almost from
the outset.
Jodi,
Depending on the specific problem of the child, often inhibiting the front of the tongue

(with a tongue depressor, lollipop, your gloved finger), while the child attempts to
produce the /k/ or /g/, leads to successful productions. Then fade the direct physical
prompt.
may need to get off the chat soon- anyone with insight on getting children with
significant artic and om issues off of bottles and pacifiers??
Here's an idea that I have found successful. With my students who exhibit verbal
dyspraxia, I use a verbal cueing system that does not just include a model. I tell them
specifically what to do with their articulators:
For /s/ - "Teeth together, bite and blow"
For /l/ - "Tongue tip on the Magic Spot" (alveolar ridge)
For /f/ - "Top teeth on your bottom lip, bite and blow"
I give them the verbal cue for each production. They have gotten so used to the
specific statements, that if either I or their parent says it incorrectly or differently, the
child will correct us!
Betty Maxwell Betty - 09:28pm Sep 23, 2003 EST (#181) {Bookmark}
Hi from northern California:
I use OME as a last resort. It did help to stop one of my CP students from having to
wear a bib as a result of drooling.
I have found OME has helped improve stability of the jaw, increase awareness of oral
musculature, positioning, and movement of the tongue back into the mouth, all
precursors for improved articulation success. It has helped to reduce gag reflex and
improve production of /k/ and /g/ which was being distorted due to production by the
blade of the tongue.
I have had little success using it for VPI: my student can blow the blow toy at the top
of SRJ's hierarchy as well as suck fairly viscous liquids through a straw. The plastic
surgeon insists with those skills he should be able to obtain VP competency during

speech. Certainly increasing aspiration of pressure consonants helped intelligibility, but
it has done little for his hypernasality. I've also tried SRJ's suggestions of alternating
nasal vs other speech targets but my client stills sounds very nasal to me. Any
suggestions?
Heather and REnee,
The response to the intervention, in the case of our work - strengthening, may be two
fold - central (brain) and more peripherally (muscle). So Heather, I agree with your
perspective and appreciate your comments. We are collecting functional MRI of the
brains of our strengthening patients and quantifying a measure we call (brain effort) in
addition to muscle mass with the anatomical MR imaging of muscle. It is a very
interesting process....can't wait to see what we find. The problem is, it will take a
couple of years to complete and as we see from this very busy WEB forum, as usual we
would like to have some practice guidelines before the data are in!
Aileen,
Again, how old are these children? And is it the children who are having difficulty
getting "off" the bottles and/or pacifiers, or the caregivers who are having difficulty
"getting" the children "off?"
I am unaware of any oral-motor treatment projects currently funded by ASHA or any
other agency, but I hope this is just ignorance. Joanne's work is at least one example
related to swallowing, but I just don't know about other funded work - Karen or
Joanne, do you know more?
Jacquie Jacquie F. - 09:30pm Sep 23, 2003 EST (#185) {Bookmark}

Erin,
I like your verbal cueing system. I try to do a similar cue, however, I have the hardest
time with the /r/. Any ideas?
Linda Schmitke Schmitke - 09:30pm Sep 23, 2003 EST (#186) {Bookmark}
Several of us have mentioned the "integration factor" in associating OM ex. and speech
or swallowing. Karen (8:31pm) mentioned that clients "become aware of articulators",
Sandy (8:39)speaks of "integrating behavior", later others mentioned "increasing
sensory and proprioceptive abilities" and OM "exercises to increase metacognitive
awareness".....seemes reasonable to me that indeed, we do stimulate a number of
holistic factors which should, depending upon an individual's capacity to be stimulated
in these areas, enhance ability to approximate speech movements. I think the key
word here might be "holistic" approach??
Karen Forrest's work is funded by the NIH, isn't it Karen?
30 minutes to go sysop - 09:31pm Sep 23, 2003 EST (#188) {Bookmark}
We've only got thirty minutes left to the forum tonight, and I know there's a bit of a
backup on questions (kudos to our guests for doing so well at keeping up with so many
of them!). I'd like to ask our audience to go ahead and post any final questions now, to
give our presenters time to answer them before we end this at 10pm ET.
debra, i'm sorry i was away for a couple of minutes
to be quite honest i can't remember working with someone specifically for oral
dysphagia, who could not follow directions. if they were unable to follow dir. due to
dementia i often find that the deficits they present with are cognitive related and not
primarily muscular. and those people who may have severe language deficits affecting

comprehension to the point of not being able to follow commands with a model and/or
other cues, i don't remember hvaing a pt. like this and working on oral dysphagia at
that stage
Kathleen Church kate church - 09:31pm Sep 23, 2003 EST (#190) {Bookmark}
Hi, I see a 6 year old girl with Down Syndrome who is apraxic. What are your
thoughts? I personally feel that oral motor exercises are not effective but I am open to
different opinions. Any thoughts? Thanks.
I can't remember who requested this info, but here are a couple of the studies that I
have on hand.
International Journal of Orofacial Myology Volume XVII
Hahn and Hahn
Efficacy of Orofacial Myofunctional Therapy
Pages 21-23
IJOM
Denkert
1997 Volume XXIII
Pages 35-46
The Effectiveness of orofacial myofunctional therapy in improving dental occlusions
Certified Orofacial Myologists have created their own treatment programs. A great
book to learn more is by:
Hanson and Mason
Orofacial Myology 2nd edition
Publisher: Charles C. Thomas
Springfield, IL
Kay Jellison for Joann Smithpeter

Joanne,
What kind of exercises are you including in your current research? Are the exercises
only for those who can follow commands?
Janice,
Working on the straw drinking exercise (and I am referring to Sara Rosenfeld-
Johnson's hierarchical approach, not just putting a straw in the mouth) achieves the
retraction they are lacking in my experience. Once I see tongue retraction, teaching
the sound is through awareness. If the tongue is in a protruded or forward position at
rest or during feeding, I see the same in speech. It seems that many of these children
learn to compensate in some way (often by clinching their teeth together) but can
never carry the movement over into co-articulation. We have begun a "research study"
looking at children's ability to drink from a straw in Sara Rosenfeld-Johnson's straw
drinking hierarchy (Straw #7 if you are familiar) and their ability to produce the /s/
and /z/ sound. I've been to 20 day-cares and over 90% of the time, those children who
had an /s/ or /z/ distortion, could not drink from this straw using lip protrusion and
tongue retraction. Unfortunately, I am not a research scientist and cannot tell you why
that is. I can only question that there must be some correlation in these skills.
Denise Ruscio Russpeech - 09:33pm Sep 23, 2003 EST (#194) {Bookmark}
Regarding the comments on understanding the relationships between the articulatory
and other systems - I have a wonderful O.T who acts as my resource guide. Also, when
I teach my classes on speech-language development, I always discuss the correlations
across domains, and connect communication with development in other areas. Gaining
insight into SID has made my therapy mush more successful, in terms of selected
stimuli, organizing the client, providing proprioceptive input prior to production work,
etc. Multidisciplinary treatment, when available, should be utilized.
hello Roberta- children are 3 1/2 and 4 years old. In terms of the child with pacifier-
child leaves it at home during school time but screams for it all day at home and parent
insists that it is needed to fall asleep at night! Child on bottle is close to 4 years old-

has a hard time drinking from a cup- major oral motor issues but can do so with
assistance. thanks!!!!!!
Kathleen Dauer kdauer - 09:33pm Sep 23, 2003 EST (#196) {Bookmark}
Renee,
My question would be even if the oral motor movements and speech movements were
similar, which thus far there is no data, why wouldn't you just want to kill to birds with
one stone by working on both at the same time.
By doing speech movements you are definitely also working on oral motor movement.
Linda,
Yes. Or a multi-modal, multi-sensory approach. Some children learn better through
modalities which are different from the modalities other children learn better from.
Shouldn't we utilize all of the modalities rather than just one? Articulation is a motor
skill. If children have not learned to produce sounds correctly through the auditory and
visual channels, then why not try an additional modality (motor, sensory) (not instead
of, but in addition to)?
Renee,
Actually, there is some research that is ongoing in this area. We have NIH funding to
investigate a number of factors that influence speech sound acquisition, including
treatment protocols. We are doing a direct comparison of OME and production training
in children with very limited phonetic inventory. We have just finished our first year of
funding so we don't have much to offer by way of results.
Actually, I think that "simply therapists" may be a very good source to obtain good
data. Even single-subject studies would be helpful, especially if there are replications of
the studies.
I'd agree with you that stopping research because it is controversial is nuts! I believe
that the controversy that exists is spurring some researchers to develop studies to

investigate the issue more objectively.
Jacquie,
I, too, have difficulty with those various R phonemes. I'm going to look into it more &
would like to discuss it with you after the Forum. You can email me at
dyere@belleville.k12.wi.us
Betty,
if the child is hypernasal I suspect they have a residual velopharyngeal incompetence.
It sounds like a full evaluation of velopharyngeal mechanism is in order. This might
include Nasometry, pressure flow, and nasal endoscopy (or multiview videofluoroscopy
if endoscopy is not available). I have the greatest of respect for my surgical colleagues
but there are very few I would actually trust to evaluate velopharyngeal functioning-
especially if they are the ones that if the initial surgery.
Kathleen,
I think that with many of the clients that I work with who have little to no intelligible
speech production, you can't kill 2 birds with one stone. If I can't get a lingual alveolar
sound without tongue protrusion, I can't see why I would want to work on production
of the sound in error. I see it more beneficial to correct the tongue placement first and
then target the sound if necessary.
Yes, Debra, the 8 week exercise protocol we are testing requires the client to follow
instructions and actively perform. In essence, they are pushing the tongue against a

resistance and obtaining feedback indicating how close to the target pressure they are
achieving. The target is set at 60% of their maximum pressure for the first week and
moved to 80% of target maximum presssure for the next weeks. The protocol reflects
that advocated in Sports' Medicine literature. Patients perform the protocol 3
days/week for the 8 weeks. We collect our data points pre-protocol, at the 4 week
point and at the end of 8 weeks. So far, our findings are very promising but it is early.
Kathleen,
Speech and non speech movements are not related in a linear fashion, but rather in a
dynamic fashion, and our system for orofacial movement is wonderfully adaptive, so
that if one movement is not working well, other muscle groups help, for example, weak
lower lip is assisted by increased mentalis activation. Function is impacted when the
compensatory movement patterns are not adequate for function, either speech or non
speech activities.
Say, Karen, would you be willing to discuss some single subject research designs with
me after the Forum sometime?
I believe that in the schools, we have a wealth of subjects and potential researchers.
We just need help getting organized!
There seems to be a lull so I thought I'd add some thoughts on topics not yet
discussed:
With respect to strength training, several other issues are relevant (in addition to
speech/non speech):
Strength training is generally contra-indicated for individuals with hypertonicity,
although some rehabilitation professionals have argued that strength training can be
conducted when tone has first been reduced using passive stretching and physical
modalities. Clinicians therefore must be able to identify hypertonicity.

Patients vulnerable to fatigue or with disabled recovery mechanisms probably can’t
benefit from strength training. Instead, completing exercises will fatigue them, actually
making their functional abilities worse, without any hope of ultimately gaining strength.
It seems like strength-training is often prescribed for individuals without weakness (but
rather with perhaps disrupted movement patterns?). It’s hard to see how this is
appropriate.
I am in agreement with Erin! If I can find someone (ANYONE) that is willing to give me
guidance, I would LOVE to become more involved in research. I just don't know the
parameters, etc...that are involved.
Greg,
I used the term empirical to denote my own observations and experience with children
who were unintelligible and made very slow progress with traditional methods alone
and who upon the introduction of targeted OME along with continuation of traditional
methods, made progress at an increased rate. This does not meet the requirements
delineated above in the evidence-based practice, nor is it published. In my practice,
that introduction/change is what WORKED (albeit in combination with the other
methods.)
Joanne,
When you are ready to research the response with individuals who cannot follow
commands, I have some interventions to contribute. In fact, I am willing to help with
any prospective, randomized double blind, ababa design study with specific oral motor
interventions. The University of South Florida is in the planning stages for such a
design. I will definitely keep you posted on the progress of that indeavor.

Gotta go. Thanks to the SIDs and participants for this exchange.
Lisa McDonald mcdonal - 09:45pm Sep 23, 2003 EST (#210) {Bookmark}
All the information has been very interesting this evening. Thanks for the abundance of
facts, opinions, and helpful resources.
N. teknomom - 09:46pm Sep 23, 2003 EST (#211) {Bookmark}
I have an 8 year old on my caseload who has been diagnosed with dysarthria - he
exhibits interdentalization of /s/, low affect, reduced prosody and intonation, affecting
intelligibility of speech. Has anyone tried to incorporate elements of LSVT into their
treatment plans with school-aged kids?
From Texas: Thank you so much to all the experts. I just wanted to say that I have
enjoyed *all* of the information and points of view. The time has flown! I have
certainly dusted off some speed reading techniques tonight.
To All,
Thank you so much for your participation in this forum. I am certain that eventually,
research will address current practice to help us all better target functional
improvement for those we serve.

I'd love to help design some single subject studies! I think that collaboration between
researchers and clinicians is a great idea. So, please contact me. Also, this might be a
good topic for an ASHA convention session.
As far as oral myofunctional therapy, aren't the references that are cited more related
to tongue thrust, swallowing and occlusion? Do any of the references relate the
therapy to speech?
This is not a wrap-up, I just wanted to catch people before they sign off. I was asked to
post contact information for each of the discussion leaders (this info is also at the
beginning of the web forum).
Debra Beckman, MS, CCC-SLP
Beckman & Associates, Inc.
Developmental Therapy Clinic
Winter Park, FL
Heather M. Clark, Ph.D. CCC/SLP
Associate Professor, Department of Language, Reading, & Exceptionalities, Appalachian
State University
Boone, NC
Karen Forrest, Ph.D.
Professor, Department of Speech and Hearing Sciences, Indiana University
Bloomington, IN
John E. Riski, Ph.D., CCC-S, FASHA
Director, Speech Pathology Laboratory
Clinical Director, Center for Craniofacial Disorders
Atlanta, GA
JoAnne Robbins, Ph.D.
Professor, Department of Medicine, University of Wisconsin
and
Associate Director for Research, Geriatric Research, Education and Clinical Center
(GRECC)
Wm S Middleton VA Hospital
Madison, WI

Billy - I hope you got the information on Orofacial Myology. Please feel free to e-mail
us with any further questions:
spchpathpc@aol.com
Kay Jellison
Michelle Ferketic Michelle Ferketic - 09:50pm Sep 23, 2003 EST (#217) {Bookmark}
For funding information, please see the American Speech-Language-Hearing
Foundation's web page. Also, the ASHA Research unit provides information on funding
sources and grants. Both can be accessed from the ASHA web site.
DeAnna Trujillo dltslp - 09:50pm Sep 23, 2003 EST (#218) {Bookmark}
Karen,
Thank you for expressing the sentiments of what surely must be MANY "non-official
researchers" in our field. While we may never be published in a journal, our practical
applications and day-to-day observations provide valuable insight which should not be
easily discounted.
DeAnna
Karen,
If you wish to go to ASHA next year and consider a session, I may join you in
developing it. It might be fun to think a session through together. Let me know your
level of interest - I'm not even sure where the meeting is next year!
Kathleen Dauer kdauer - 09:51pm Sep 23, 2003 EST (#220) {Bookmark}

Renee,
In my opinion approximations of sounds are better than no sound at all and I can
always shape those sounds. I allow close approximations with all my apraxic kids and
shape the sounds. The kids that I am talking about do not demonstrate feeding or
swallowing issues.
I just have to mention that 25 years ago I was first employed as an SLP at the Institute
of Logopedics in Wichita, KS. It was founded by Dr. Martin Palmer. IOL was a private
institute dedicated to working with children and adults with communication disorders. I
believe that Dr. Palmer did maintain that non-speech movements and speech motor
movements were the same. Many a person with Cerebral Palsy who attended IOL
learned to speak based upon this premise and the types of OME which were
incorporated into their therapy programs.
I look forward to seeing more research occurring in the future that will provide
additional insight into this issue. I've always found the topic fascinating.
I definitely would love to look further into some research possibilities. I will be in touch!
I really think Sara Rosenfeld-Johnson's work should be looked into further as it has
changed my therapy completely. It is so nice to have a measurable program that has
taught me how to combine an oral-motor approach with what I have already learned in
addressing production.
Please also see a message posted early in the forum related to sessions at this year's
ASHA that address this topic.
Wrap-up sysop - 09:54pm Sep 23, 2003 EST (#224) {Bookmark}

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